Chest X-ray PA View Research Articles

S1436 Outcome of the Use of Corticosteroids for Treatment of Autoimmune Pancreatitis (AIP) in a COVID-19 Patient

INTRODUCTION: Autoimmune Pancreatitis (AIP) is a steroid-responsive disease of the pancreas. Due to poor outcomes in severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV) outbreaks, the World Health Organization (WHO) advises against the use of corticosteroids in the treatment of 2019 Coronavirus Disease (COVID-19) except if steroid therapy is required for coexisting illness. We present a case of uncontrolled AIP which was treated with high dose steroids while the patient was hospitalized with COVID-19. CASE DESCRIPTION/METHODS: A 53-year-old male was hospitalized with COVID-19 and uncontrolled AIP. The patient had elevated IgG4 levels and negative work up for other etiology of pancreatitis in the past and was already taking prednisone 40 mg daily due to a recent AIP exacerbation. On physical exam, temperature of 101 F, heart rate 101 beats/minute, respiratory rate 20 breaths/minute while blood pressure was normal. Tenderness in the epigastric region was noted. Labs showed Hct 35.8%, WBC 12.32 thousand/uL, BUN 9 mg/dL, lipase 530 u/L and normal LFTs. CT abdomen showed severe necrotizing pancreatitis with infected necrosis (multiloculated collections of gas and fluid) (Image 1). Chest imaging showed bibasilar infiltrates consistent with COVID-19 pneumonia (Image 2). Patient was continued on steroids, started on meropenem, and supportive treatment for COVID-19. Due to persistent abdominal pain and inability to tolerate oral intake, the patient underwent CT-guided percutaneous drainage of the necrotic collection. Azathioprine (AZA) was added to treatment regimen due to uncontrolled AIP despite steroid therapy. Patient recovered clinically without need for oxygen supplementation or further complication from COVID-19. He was discharged from the hospital with a short antibiotic course, a prescription to continue AZA and prednisone 40 mg with plan to taper dose by 5 mg per week. He returned home to continue quarantine which he completed without problems. DISCUSSION: Despite having multiple risk factors associated with poor outcomes in COVID-19 (age greater than 45 years, male gender, comorbidity due to uncontrolled AIP and immunosupression with steroid treatment), our patient experienced complete resolution of the illness with supportive measures. Our case supports current recommendations advocating steroid therapy for co-existing diseases in patients with COVID-19.Figure 1.: Image 1. CT scan abdomen shows multiloculated ill-defined of herterogeneous consistency as well as presence of gas pockets in the pancreatic and peri-pancreatic tissues, consistent with infected pancreatic necrotic collection in (A) and (B).Figure 2.: Image 2: Bibasilar lower lung infiltrates seen on CT scan chest (A) and Chest X-ray PA view (B), consistent with COVID-19 pneumonia.

Evaluation of pulmonary complications in patients undergoing allogenic stem cell transplantation

BackgroundMature blood cells can be differentiated from hematopoietic stem cells; thus, the latter can play a crucial role in maintaining defense against different microorganisms. Thus, hematopoietic stem cell transplantation is one of the most important lines of immunotherapy. Major systemic complications may occur post transplantation and could be fatal. Pulmonary complications include infectious and non-infectious complications. The aim of this study was to detect the pulmonary complications in allogeneic stem cell transplantation patients.ResultsWe studied 20 patients after transplantation of allogeneic stem cells with regular follow-up in outpatient clinic of hematology department of Alexandria Main University Hospital. All the studied patients were subjected to history taking, plain x-ray chest PA view, CT chest, complete blood count, serum creatinine, liver enzymes, and serum cytomegalovirus (CMV) detection by antibodies IgG and IgM. Regarding sputum sampling, 7 patients’ samples (35%) were obtained either spontaneously or by induction via hypertonic saline 3%. One patient (5%) had miniBAL done, while bronchoalveolar lavage using fiber optic bronchoscopy was done for 2 patients (10%). Samples could not be obtained from the remaining patients. Samples were analyzed for culture for bacteria, Pneumocystis jiroveci using immunofluorescence test, CMV PCR, fungal culture, and smear for acid fast bacilli (AFB). Among the examined patients, 2 patients (20%) had pulmonary bacterial infection including streptococcus and multidrug-resistant strain of Klebsiella, 3 patients (30%) had pulmonary candida infection, and one patient (10%) had positive result of pulmonary CMV of low count which was considered insignificant. None of our patients had positive results for pulmonary tuberculosis nor Pneumocystis jiroveci. Six patients (30%) had CMV in serum; 3 patients (15.8%) had manifested CMV reactivation. One patient (5%) of our patients had pulmonary graft versus host disease GVHD. One patient (5%) had died during our study course within 12 days post-transplantation due to ARDS followed by multiple organ failure.ConclusionThe prevalence of pulmonary infectious complications after allogenic stem cell transplantation was 50% of all studied patients, while 5% of the studied patients presented with non-infectious pulmonary complications.

Clinical profile of tracheo-bronchial foreign body inhalation at tertiary care center

<p class="abstract"><strong>Background:</strong> Inhalation of foreign bodies can be life threatening and are common in paediatric age group with peak incidence in the age group of 1-3 years. The objectives were to study the clinical profile of foreign body (FB) inhalation and to study the complications of tracheo-bronchial foreign body and rigid bronchoscopy.</p><p class="abstract"><strong>Methods:</strong> A cross-sectional hospital based diagnostic study conducted for 1 year, done on 50 patients with FB inhalation, included consecutively in study after obtaining informed consent. Patients were assessed and interviewed for socio demographic details and examined using chest X-ray PA view, routine investigations and pre-anaesthetic evaluation. After all investigations a diagnostic bronchoscopy under general anaesthesia was performed to extract the foreign body. Data were analyzed through tables and diagrams and appropriate test of significance by Epi Info software. </p><p class="abstract"><strong>Results:</strong> Total 50 FB inhalation cases (up to 10 years) in which 40% presented within 5 days to 2 weeks after inhalation. 92% were presents with cough and on chest examination 88% found to had decreased air entry, 72% presents with decreased movement and dull percussion on affected side. 70% of patients had abnormal chest X-ray finding. Foreign body found were groundnut (44%) followed by supari (32%) mostly in right main bronchus. We observed 10% patients with pneumonia, 4% had granuloma and 2% had bronchospasm.</p><p><strong>Conclusions:</strong> Prevention is best, but early recognition remains a critical factor in the treatment of FB inhalation in children. </p>

Is the clinic pathological profile of hypothyroidism gradually changing: a comparative study from North India

Background: Thyroid dysfunction has been subject of academical and therapeutically interest not only to the endocrinologist but also to the disciplines of medicine. Statistical data and studies on hypothyroidism are scanty, clinical picture is varied, investigations are usually not available at all levels and therefore to enlarge clinical profile of hypothyroidism minimal base line investigation, clinical approach and effects of replacement therapy and complications are to be studied.Methods: Observational cross-sectional study conducted among patients with hypothyroidism registered at the Air Force Central Medical Establishment (AFCME) New Delhi.Results: Among 50 patients with hypothyroidism were enrolled in this study during the study period. Idiopathic hypothyroidism was present in 98% patients while only one patient (2%) had Hashimotto’s thyroiditis. Generalized weakness was the commonest presenting symptom followed by lethargy and anorexia. Thyroid swelling was diffuse in nature with no predilection to right or left lobe enlargement. Hypertension (40%) and ischemic heart diseases (36%) were the most common comorbid condition. Mean serum TSH was elevated while serum T3 and T4 values were reduced. Antithyroid antibody titre was positive in more than seventy percentage of patients. X-ray among patients revealed cardiomegaly in ten patients (20%), pulmonary Koch’s in (4%) of patient and in rest of patients x-ray chest PA view was normal. ECG changes showed low voltage on electrocardiogram in (20%) of patients and sinus bradycardia in (24%) of patients. Most of the patients were put on replacement therapy (L. thyroxine) in dose of 1.6 - 1.7 mcg/kg/day.Conclusions: Hypothyroidism as a clinical entity is common between 4th and 6th decade of life and seen more among females. Though etiology remained unknown in majority of the patients, weakness, and lethargy were the common clinical presentation.

Incidence of triple negative breast cancer at Rajendra Institute of Medical Sciences, Ranchi

Background: Breast carcinoma is the second most common carcinoma in women and accounts for 22% of all female cancer, which is more than twice the prevalence of cancer in women at any other site. Triple negative breast cancer, i.e., negative expression of oestrogen and progesterone receptors and HER2/neu receptors and accounts for approximately 10-17% of all breast carcinomas, is biologically aggressive, resistant to conventional cytotoxic chemotherapy treatment, and is associated with reduced survival compared to other subtypes of breast cancer.Methods: History, local examination, Various investigations like: FNAC of breast lump and axillary lymph node, USG of breasts and axilla, USG of whole abdomen and pelvis, Chest X-ray PA View etc, ER/PR and HER-2/neu status on the specimen sent for HPE were done. The prognostic implications on ER, PR and HER-2/neu receptors were assessed indirectly with the help of Nottingham prognostic index (NPI)).Results: A statistically significant correlation of ER/PR receptor status was found with tumour size, no. of lymph nodes, tumour grade and NPI, whereas HER2/neu receptor status had a statistically significant correlation with tumour size and no. of lymph node involved. Incidence of triple negative breast cancer in this Institute is 20%.Conclusions: ER, PR and HER2/neu receptor status is highly important predictor in cases of carcinoma breast which necessitates routine evaluation of these receptor statuses for better management of disease.

Autobullectomy: A rare case of spontaneous resolution of infected giant bullae

Introduction: Bullous lung disease is a common presentation in patients with chronic obstructive pulmonary disease (COPD). The giant pulmonary bulla occupies one third of involved hemithorax and characterized by the existence of centrilobular emphysema in non bullous lung. Sometimes air reabsorbs spontaneously leading to shrinkage and regression of bulla known as autobullectomy. Mechanism of autobullectomy remains unclear. Here, we report a patient with infected bulla who experienced complete resolution after antifungal treatment. Case History: A 63 year old mal with history of twenty pack years of tobacco smoking came to the pulmonary outpatient department with complains of left side chest pain, cough with mild expectoration and low grade fever since five days. Patient also had blood tinged sputum since three days. His chest X-Ray PA view showed a thin walled cavity with air fluid level on the left upper zone with a few calcified parenchymal foci. Patient had symptomatic improvement after two weeks of antifungal treatment. Repeat skiagram chest and CECT chest showed complete resolution of bulla. Discussion: There are two hypotheses which can explain occurrence of bulla: Conclusion: Spontaneous resolution of giant bulla also known as autobullectomy is an ignorant event and follows an infection trigger. The early suspicion and diagnosis by the treating physician can avert the need for a surgical bullectomy in these patients and decline the morbidity and mortality. Our case is of interest not only because of the rarity with which spontaneous regression has been reported in the literature but also because the source of infection was fungal.

Prevalence of Hypertension in Hemorrhagic Stroke at NGMCTH, Kohalpur

Aim: To study the prevalence of hypertension in hemorrhagic stroke in patients admitted in medical units of Nepalgunj Medical College Teaching Hospital (NGMCTH), Kohalpur.
 Background : Hemorrhagic stroke has remained a serious disease despite recent advances in medical treatment. It is one of the most common emergencies encountered in clinical practice and predominantly effects elderly population leading to chronic disability and dependency. This study was designed to identify hypertension as a major cause of Intracerbral hemorrhage (ICH).
 Material and methods: This is a cross sectional descriptive study conducted in the department of medicine of NGMCTH, Kohalpur between June 2017 and November 2017. A total of 51 patients were included in the study. History and clinical examinations were recorded. Plain CT scan head, ECG and chest x-ray PA view were done and the data were recorded and analysed.
 Result: The age of patients ranged from 48 to 89 years with the mean age of 66.72 years. Among 51 patients, high BP at presentation along with ECG showing LVH was seen in 38 patients (74.5%) and chest x-ray PA view showing cardiomegaly was seen in 31 patients (60.8%). Most commonly involved ethinic group was Tharu (45.1%).
 Conclusion: Hypertension is a major cause of ICH. So, early detection and regular treatment of hypertension with appropriate antihypertensive drugs and life style modification would prevent ICH.

Presence of Left Ventricular Diastolic Dysfunction in Patients of Chronic Obstructive Pulmonary Disease

The relationship between chronic obstructive pulmonary disease (COPD) and cardiovascular diseases strongly exists as diastolic dysfunction is commonly reported in COPD patients. Objective: This study was conducted to determine the presence of left ventricular diastolic dysfunction in patients of COPD. Material and Methods: A cross sectional study was conducted in Mayo Hospital Lahore for one year. A total of 50 confirmed cases of COPD were included in the study. History of smoking was taken and subjects were examined for positive signs for the clinical, ECG, x-ray chest PA view and pulmonary function tests. Additionally, they were subjected to echocardiography and left ventricular diastolic dysfunctions were noted. Results: In our study, mean age of the patients was 60.7±6.2 years and mean FEV1/FVC ratio was 56.9±14.3%. Similarly mean ejection fraction of the patients turned out to be 60.6±4.6. The mean peak mitral filling velocity of the patients was 69.8±15.9 cm/s. The mean peak mitral filling rate of the patients was 57.2±30.9 cm/s and mean E/A ratio was 1.3±0.3. The mean iso-volumetric relaxation time of the patients was 84.2±14.7 msec. The mean mitral E deceleration time of the patients was 187.4±25.1 msec. The mean atrial flow reversal was 0.28±0.04. There were 14 (28%) patients having left ventricular diastolic dysfunction. Conclusion: COPD patients had left ventricular diastolic dysfunction and it was related to increase in pulmonary artery pressure.

A case of bilateral IJV thrombosis with left massive pleural effusion

We report a case of middle aged male who presented with swelling of the neck since 2 months and shortness of breath since 1 month without any antecedent illness. Clinical examination was suggestive of diffuse neck swelling with left massive pleural effusion. USG neck revealed bilateral IJV thrombosis with diffuse neck cellulitis. Chest x-ray PA view showed homogenous opacity in the left upper and lower zone with obliteration of the costophrenic angle suggestive of left massive pleural effusion. CECT neck was done which suggested thrombosis of bilateral IJV with subcutaneous oedema with fat stranding noted in the neck with loculated abscess. CECT thorax revealed left massive pleural effusion with passive atelactasis of left lung. Pleural fluid cytology was suggestive of lymphoproliferative disorder. He was initially treated with antibiotics and anticoagulants. Patient was later referred to Oncology department for further management. Conclusion: Bilateral IJV thrombosis is a rare condition and also life threatening. It has been associated with various etiologies especially malignancies. Thus the diagnosis of bilateral IJV thrombosis needs extensive workup for any internal malignancies. As early detection and appropriate management can be lifesaving.

Unusual case of nail in lung

Tracheobronchial foreign body aspiration is a health problem that can be seen in all age groups, and it requires urgent diagnosis and intervention. We report an unusual case of nail in lung. 45 years old male was referred to us with history of aspiration of nail 2 Days back and cough. X-ray Chest PA view showed radio-opaque foreign body in right lung-lower zone. Patient had undergone bronchoscopy 2 days ago with report stating, “Normal study; No foreign body Seen” Counselling of the patient and relatives was done. Informed consent was taken. Under general anaesthesia with intubation, fluoroscopy guided video bronchoscopy was performed with external diameter 5.6mm and working channel 2mm. Foreign body was localized and removed It’s an innovative technique with multi-disciplinary approach. Counselling of the patient and relatives is important.

Study of etiology of pleural effusion in the district hospital, Shimoga

Introduction: Pleural effusion is an indicator of a pathologic process that may be of primary pulmonary origin or of some other systemic disease. Determining the etiological of PE helps in adoption of regionally optimized diagnosis & therapeutic approach. Materials and Method: Study is conducted on 100 consecutive patients admitted in various medical wards of the Mc Gann Hospital attached to Shimoga Institute of Medical Sciences, Shimoga. From June 1st, 2016 to January 30th 2017 detailed history was taken in all the patients and a through physical examination was done. Routine investigations were done for all patients. Chest X-ray PA view taken. All the patients were subjected to diagnostic thoracentesis. Under aseptic precautions about 20 ml of fluid was aspirated and subjected to analysis pleural fluid cell count, cell type, sugar, protein and AFB stain done. Results: There were 60 males and 40 females. The mean age was 36±2.2 years. Fever and cough were the most common clinical features seen in 64% and 76% respectively, followed by chest pain (44%) and breathlessness (42%). Tuberculous pleural effusion (64%) was more common than non tuberculous (36%) pleural effusion. Among non tuberculous pleural effusion synpneumonic and malignant effusion were common. Tuberculosis has predominant lymphocytic pleural effusion with cell count less than 200. Conclusions: Aetiological evaluation of pleural effusion is very important for management of the disease. This is important because management is different for different cases. Pleural fluid analysis can be considered as gold standard in evaluation of pleural effusion. Keywords: Cell Cytology; Pleural Effusion; Thoracocentesis; Tuberculosis

A Study on the Clinical Presentation of Hiv-Tb Coinfection and Its Correlation with Cd4 Count

INTRODUCTION: The burden of TB and HIV /AIDS poses unprecedented challenges on the public health system in India. TB and HIV are overlapping epidemics. They are closely interlinked. Untreated HIV infection leads to progressive immuno deficiency and increased susceptibility to infections including TB. TB is the leading cause of HIV related morbidity and mortality. HIV is the most important factor fuelling the TB epidemic in populations with a high HIV prevalence in many countries especially in sub-Saharan Africa and increasingly in Asia and South America. Studies have shown that there is close association between HIV and TB. Evidence of this interaction included several observations repeatedly made by WHO, National governments and funding partners. These observations are • The areas that have been mostly affected by HIV epidemic also report the greatest increase in the incidence and prevalence of the TB. • The largest increase in TB cases has occurred among people aged 25-40 years. The very same age group mostly affected by HIV/AIDS. • TB is the most common opportunistic infection among AIDS patients(Between 60-75% of AIDS patients will develop TB). • HIV prevalence among TB patients is higher than in the general population. (It is estimated a prevalence of 5.2% of HIV in adult TB in India). AIM OF THE STUDY: 1. To study the clinical presentation of tuberculosis in HIV positive patients. 2. To study the correlation of CD4 count with the radiological findings of Pulmonary tuberculosis. MATERIALS AND METHODS: Place of Study : Department of Medicine, KMCH Type of Study : Cross sectional Study Collaborating Department : Chest Clinic, ART Clinic. Duration of Study : January 2006 to July 2007 Case Selection: INCLUSION CRITERIA: • Patients who have been diagnosed as HIV positive either by Rapid Test or ELISA and who have clinical and investigatory evidence of pulmonary TB or Extra pulmonary TB are enrolled in the study. These patients are picked up from ART Clinic. • Those patients who sought medical attention for any form of Tuberculosis at chest clinic OP, who are HIV negative, are chosen as controls. • Patients between the age group of 15 to 55 are enrolled in the study. EXCLUSION CRITERIA: • Patients below the age of 15 and above the age of 55 are excluded in the study. • HIV positive individuals who did not have clinical or investigatory evidence of any form of TB were excluded. • Patients who had other causes of immuno suppression such as Diabetes, Lymphoma, Leukemea, visceral malignancy, malnutrition, on immuno suppressive drugs were excluded. METHODOLOGY: All HIV positive patients were meticulously examined for the presence of Pulmonary and Extra pulmonary Tuberculosis. Their symptoms were analyzed in a detailed manner. Complete general examinations for presence of opportunistic infection and respiratory system and other system examination were done. All of them were subjected to the following investigations. Basic blood investigation, sputum smear for AFB, chest x-ray PA view, PPD reactivity by mantaoux test and CD4 count. Special investigations were done in patients with extra pulmonary TB like FNAC of lymphnode, biopsy, and CSF analysis. RESULTS: A total number of 60 patients of HIV +ve TB and 30 patients HIV -ve TB were enrolled in this study. All the data were fed into a computer and the results were collected using an epidemiology incorporated software. The following test statistics were used 1) two sample t test, 2) wilcoxon Rank Sum test/Mann -Whitney test, 3) Chi-square test, 4) Fisher -exact. CONCLUSION: 1. As TB is the most common opportunistic infection in all HIV positive individuals, hence all HIV patients should be screened for TB and all TB patients should be screened for HIV status. 2. Tuberculosis has multiple clinical presentations in patients with HIV infection. 3. Atypical chest x-ray findings are common in HIV-TB co infection. 4. The most common atypical presentations are mediastinal adenopathy, lower zone infiltration and miliary mottling. 5. Cavitation is rare in HIV-TB co infection. 6. When the CD4 count is more than 200, upper zone infiltration is more common. When the CD4 count less than 200 atypical xray findings are common. 7. Sputum smear negativity is more common,hence sputum culture is essential as a screening procedure . 8. Mantoux test often is false negative in HIV-TB co infection. 9. Lymphnodes, meninges and pleura are the common sites of extra pulmonary TB involvement. 10.Tuberculosis can occur at any level of depletions of CD4 count but when the CD4 count level is grossly low extra pulmonary TB is more common. Since TB-HIV fuel each other, early diagnosis and proper effective management are essential to reduce the morbidity and mortality.

Management of Spontaneous Rectal Perforation at Up-Coming Medical College Hospital: A Rare Occurrence

Spontaneous perforation of large bowel compare to small bowel is very uncommon and among them “spontaneous rectal perforation” is very rare cause of acute abdomen in surgical practice. The presentation of such entity is similar to any other cause of peritonitis & pre-operatively definite diagnosis remain a diagnostic dilemma and require an emergency surgical intervention to have the best outcome. We report a case of a 83 years male presented to our Emergency Department referred from B. P. Koirala Institute of Health Sciences with feature suggestive of peritonitis, hollow viscous perforation with evidence of free air under right dome of diaphragm in chest X-ray PA view. An emergency exploratory laparotomy was performed with provisional diagnosis of duodenal ulcer perforation as being commonest in this region with differential diagnosis of appendicular perforation or small bowel perforation with peritonitis. But on exploration no perforation was found in duodenum, small bowel, appendix and large bowel etc. Lastly with much difficulty the rectal perforation could be located while removing the plaques adhered to the rectal wall. Seeing such cases a surgeon should be aware of the possibility of this fatal disease despite rare incidence. It is very important to recognize such condition at an early stage because it carries high mortality if surgical intervention is not done at early stage. Intra-operatively too a thorough search should be made towards rectum if perforation is not found easily at other sites. Hence the better prognosis is with early surgical intervention; worst the prognosis with late intervention.Birat Journal of Health Sciences 2016 1(1): 87-90

Clinical and Etiological Profile of Acute Febrile Encephalopathy in South Rajasthan, India

Objective : To study the clinical and etiological profile of Acute Febrile Encephalopathy (AFE) in South Rajasthan. Methods : Children in the age of 1 month to 18 year with acute febrile encephalopathy were enrolled in the study. The investigations included CBC with PBF , ESR, Malarial parasite, blood sugar, kidney function test, electrolytes, liver function test, calcium, CSF examination, urine examination, X-ray chest PA view. ABG, serum ammonia, blood culture for bacteriological and virological studies and CT/ MRI brain were performed whenever required. Results : 85 patients were admitted with fever and loss of sensorium. Other clinical features included convulsion (64.70%), vomiting (45.88%), headache (16.47%), skin lesion (2.35%), parotid swelling (1.17%), signs of raised intracranial tension (21.17%), signs of meningeal irritation (18.82%), cranial nerve palsy (4.70%), abnormal involuntary movement (2.35%), hepatomegaly (55.29%), splenomegaly (38.82%), anemia (41.17%) and clinical icterus (7.05%). Cerebral malaria was the commonest cause 32 (37.64%) of AFE followed by bacterial meningitis 16 (18.82%) and Suspected Viral Encephalitis 15 (17.64%). Reye's syndrome was seen in 14 (16.47%) patients. Other etiologies were Tubercular meningoencephalitis and Hepatic encephalopathy 2 (2.35%) each, Meningococcemia, Mumps meningoencephalitis, Acute Disseminated Encephalomyelitis and Dengue encephalopathy 1 (1.17%) each. Conclusion : Cerebral Malaria was the leading cause of AFE followed by Bacterial Meningitis and Suspected viral encephalitis. While determining the etiology of AFE in a malaria endemic area, Cerebral Malaria should be considered in all patients. Reye's syndrome should also be considered and all patients of AFE should be evaluated to diagnose /rule out this entity.

Coiled Nasogastric Tube in Oesophagus

This is a image of an plain X-Ray Chest PA view of a 32 year old female postoperative patient of liver transplant. In this X- ray a nasogastric tube (NG) is seen coiled in the oesophagus which is a rare event.

Study of cardiovascular manifestations in patients of HIV- its correlation with CD4 count and the ART regimen prescribed

Background: In patients of HIV, there is correlation of CD4 count with severity of cardiac involvement. Some HAART regimens are associated with increased risk for cardiovascular events. This study was undertaken to detect occurrence of symptomatic or asymptomatic cardiac involvement in HIV/AIDS cases. Correlation with CD4+Tcell count and the ART regimen prescribed was also studied. Methods: This single point cross sectional case control study of 103 patients with HIV infection on HAART therapy was studied from April 2014 to August 2015. The study population was investigated for routine blood tests, X-Ray chest PA view, ECG, CD4 count and 2D transthoracic echocardiography. Results: The cases comprised of 43 females (41.75%) and 60 males (62.0%). Mean CD4 count was 205.48±150.06/µL and on X-ray chest PA view cardiomegaly was found in 40.78% of cases. The ECG findings were sinus tachycardia (19.42%), left axis deviation (5.82%), low voltage complexes (16.5%), right axis deviation (16.5%) intraventricular conduction delay (5.82%) and ST-T changes (8.7%) The echocardiographic findings were left ventricular diastolic dysfunction (60.24%), pericardial effusion (15.53%), dilated cardiomyopathy (23.03%), pulmonary artery hypertension (17.47%) and valvular lesions (33%). Conclusions: Declining CD4 count was associated with increased cardiac manifestations but no statistically significant difference was found in both the (TLE and ZLN) subgroups.

Chronic obstructive pulmonary disease and cardiac comorbidities: A cross-sectional study.

Introduction:Chronic obstructive pulmonary disease (COPD) is a global health issue with cigarette smoking being an important risk factor. COPD affects pulmonary blood vessels, right ventricle, as well as left ventricle leading to the development of pulmonary hypertension (PH), cor-pulmonale (COR-P), right and left ventricular dysfunction. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate cardiac functions. Early diagnoses and intervention for cardiac comorbidities would reduce mortalities.Materials and Methods:A cross-sectional study. Total 50 patients of moderate to severe COPD according to GOLD guidelines were taken from Department of Respiratory Medicine, Smt. B. K. Shah Medical Institute and Research Centre, Vadodara. All patients underwent investigations such as chest X-ray PA view, ECG, and spirometry followed by two-dimensional echocardiography.Results:We investigated 49 males and 1 female patients ranging from 35 to 80 years of age. Twenty-nine individuals were of moderate COPD and twenty-one of severe COPD. Of these cases 29 had left ventricular diastolic dysfunction (LVDD) changes, 24 were diagnosed with PH and 16 had changes of COR-P. The study showed the linear relation between the severity of LVDD, PH, and COR-P with the severity of COPD.Conclusion:Our study put emphasis on early cardiac screening of all COPD patients which will be helpful in the assessment of the prognosis and will further assist in identifying the individuals likely to suffer increase morbidity and mortality.

Value of CA-125 in diagnosis and assessment of severity of active pulmonary tuberculosis

Cancer antigen 125 (CA-125) is usually elevated in ovarian cancer. However, there are several reports that serum CA-125 is elevated in tuberculosis. Aim of the workThis study was done to evaluate the diagnostic value of serum level of CA-125 in active pulmonary tuberculosis and its relation to disease severity. Subjects and methodsThe study enrolled 80 patients who were selected from Damietta Chest Hospital and Chest Department, Benha University Hospitals in the period from July 2013 to July 2014. The subjects were classified into 3 groups: group I: included 40 patients with new diagnosed active pulmonary tuberculosis, group II: included 20 patients with pneumonia, group III: included 20 apparently healthy subjects as control group. The patients were subjected to full history taking, full clinical examination, plain chest X-ray PA view, sputum examination for AFB for three successive days by direct smear for group I & II, tuberculin skin test, CBC and ESR and serum level of CA-125 by ELIZA. ResultsThere was a statistically significant difference among the three studied groups according to the serum level of CA 125 as it was significantly higher in group I. The study revealed that serum CA 125 levels in group I was significantly higher in far advanced and moderate advanced disease than minimal lesion one. There was a statistically significant difference in serum CA 125 levels in group I regarding the results of sputum analysis for AFB. Serum level of CA125 at a cut off value of 21.05U/ml has sensitivity, specificity, PPV, NPV, accuracy of 82.5%, 72.5%, 77.3%, 83.3% and 80.0% respectively in diagnosis of active pulmonary tuberculosis. ConclusionSerum CA-125 may be used as a marker for diagnosis and assessment of severity of active pulmonary tuberculosis.

The role of noninvasive methods in assessing airway inflammation and structural changes in asthma and COPD

The aim of our study was to assess the role of non-invasive methods in assessing airway inflammation and structural changes in asthma and COPD. The study was conducted on patients attending outpatient and inpatient department of TB and Chest Diseases and Department of Pathology at our hospital from January 2006 to August 2007. 50 asthmatic and 46 COPD patients were selected. A detailed history and clinical examination, routine laboratory investigations, pulmonary function testing, Chest X-ray PA and lateral view, HRCT Thorax, biochemical and cellular analysis of sputum was carried out in all cases. Quality control and procedures of pulmomary function test were performed according to the European Respiratory Society guidelines. Bronchial wall thickening, bronchiectasis and air trapping correlated well with disease severity in asthmatics while all abnormal HRCT finding correlate well with disease severity in COPD patients. The levels of MMP-9 and TIMP-1 increased significantly with increasing disease severity in both asthmatic and COPD groups. The MMP-9/TIMP-1 ratio decreased with increasing disease severity in both groups. The major source of MMP-9 in human lungs is macrophages, neutrophils and eosinophils. Macrophages and neutrophils were also the source of TIMP-1. Asthma and COPD are characterised by an imbalance between MMP-9 and TIMP-1. COPD patients showed a higher prevalence of HRCT findings which correlate with their lower MMP-1/TIMP-1 ratio than asthmatics supporting fact that the destruction and fibrosis of alveolar walls are more prominent in COPD. MMP-9/TIMP-1 ratio is associated with magnitude of HRCT findings in asthma and COPD and suggests that level of these markers reflect the extent of structural changes of airway.

Posterior Mediastinal Chondrosarcoma- A rare entity

Introduction:Chondrosarcoma is a well defined tumor of soft tissue with calcification. Extraskeletal myxoid chondrosarcoma is an unusual sarcoma of soft tissue adding only 3% to all soft tissue tumors. Majority of mediastinal foci originates from variety of tissues, the reason being their diverse embryological and anatomical approximations. Chondrosarcomas are more common in males with 2:1 male to female ratio. The exact pathology of these tumors is unclear; however recent data ensures that these tumors have multidirectional delineation. Classical histopathological features of chondrosarcoma include S-100 positivity, EMA positivity. These features of Immunohistochemical favor extra skeletal myxoid chondrosarcoma.Case Report:Recent data signifies that the tumor is known for its rare occurrence, here we have reported a unique case of 40 years old male visited Abbasi Shaheed Hospital for pre employment checkup without any symptoms. All the tests were negative except Chest X-ray PA view which revealed dense mass on lower lobe of lung. For further evaluation, CT scan of chest with contrast was ordered and eventually the mass was resected surgically. On the basis of macro and microscopic findings, histopathological tests and immunohistochemical stains, the mass was found to be chondrosarcoma with myxoid origin. This tumor has to be distinguishing among the list of different diseases like hamartoma, hydatid cyst, and neuroendocrine tumors for the differential diagnosis of the case.Conclusion: Our paper reports an extraskeletal mesenchymal chondrosarcoma originating in the posterior mediastinum with a rare presentation.Â